Alcoholism and Drug Addiction

Alcoholism and other addictions are baffling for everyone. People who suffer from them think they are making choices. They can’t understand why things keep going awry. “I’ll try harder next time,” or maybe it was someone else’s fault. “If only they…” Family members and outsiders can’t imagine why a person would make the same destructive decisions over and over.

My way of understanding addiction starts with free will. We think we have free will and we really do, but there’s a catch. The catch is that evolution got there first to make sure we do things we are supposed to do in order for the human race not to become extinct. In fact the motivational apparatus that ensures our survival as a species has been getting stronger and more sophisticated since life first began. Let’s look at how this motivational apparatus stacks the cards to be sure we will use our free will to do what is best for homo sapiens.

We are supposed to eat when we need food, put on clothes when we are cold, drink when we need water, and make babies. If you think about it, you can see that the main way our motivational apparatus gets us to do the right thing is by making us desire it. We want to eat. And the reason we want to is that we get pangs of hunger and we also imagine how good it is going to be to sit down to a tasty meal or eat a snack. So evolution has seen to it that we get pleasure from doing the things that we are supposed to do. This is actually a very good system because it allows us the flexibility to attend to more pressing things. When we are running from danger, we don’t even think about the fact that we are hungry.

Sometimes we humans get the idea that we are smarter than our motivational apparatus. For example, sometimes our motivational apparatus thinks we need to eat, while we feel we should lose weight. Then what happens? Who is going to win? Usually, Motivational Apparatus turns out to be the winner. The reason is that MA has some tricks. When we try to go against her, first she makes us obsess. If you are told not to drink anything for the next 4 hours, first you will feel very thirsty. Then if you still don’t drink, you will begin to obsess about water. MA will send messages to your mind to try to get you to drink. If that doesn’t work, then she can control your thoughts as well! She will send you rationalizations. Think about the food rationalizations that pop into dieters minds. “It tastes so good. You deserve a snack.” “Just one little bite.” “Well, you blew your diet, so you might as well have the rest and start your diet tomorrow.” “You will never succeed, so you might as well give up this diet idea altogether.” And so on. Not only does she know how to talk you out of your resolve, but she understands how one thing leads to another. It all started with one bite, then step by step, she knows how to lead you to utter defeat.

What happens with addiction is that in some poeple, the motivational apparatus has a switch. Once it is switched, your motivational apparatus starts to think that getting “high” is necessary for the survival of the species. Now MA goes to work to find ways to get you to a drink or drug. When you resolve not to, she uses all the tricks she has learned over millions of years. That is the way I make sense of the power of addiction to destroy lives and families.

The switch is what gives addicts a completely different relationship to substances of abuse than others. How can you tell the difference? It isn’t quantity alone. There are people who drink a lot and don’t lose control. The best way I know to tell the difference starts with a look at self-preservation. MA normally makes sure that we don’t make the same mistake twice. Think about driving a car. At any moment a small movement of the steering wheel could cause death, yet we don’t make those small movements. Something very powerful keeps us from putting ourselves in danger. Many poeple have made a mistake once with alcohol. You may have thrown up, or even had a blackout where you couldn’t remember what happened the night before. The normal reaction is the same as when you let the car wander over the line. You don’t do it again. When I see a person who has had one chance to learn a lesson about substances, yet makes the same mistake again, then I am alerted. It is quite likely that this person has had the switch so that MA sees their getting high necessary for the species. That is, to me, the essence of alcoholism or drug addiction. Once the switch has happened, then despite the promises the addict may make, the situation will continue to get worse until he or she comes to an awakening often called, “rock bottom,” even though it doesn’t always have to be so terribly bad.

I put the focus on “getting high” for a reason. Even though most addicts have a drug of choice, when that one is not available or if they abstain, MA will not give up. If she can, she will substitue the next most desirable way of getting high. That is why I think of people as being addicted to getting high rather than to a particular substance.

How, then, is it possible to recover? Do you remember what I said about putting yourself in danger? Normally we simply don’t. So what force could be strong enough to motivate soldiers to put their lives in harm’s way? We know that the strongest motivating force for heroism is loyalty to the people in your platoon. The social bond is one of the few things that is strong enough to make us choose to put ourselves in jeopardy. In effect, we are pitting one biological force against another, the social bond versus preservation of the species. This is the single most powerful force for recovery.

There are different ways to bring the social bond to bear against addiction. In my experience, the one that works the most consistently is the 12 step model. AA and the other 12 step programs don’t just teach techniques for not taking the next drink, they build close social bonds between sponsor and sponsee, with one’s home group and with other groups. Fortunately these are free and available everywhere. There is a reason why they tend to work better than bonds with family or friends. Family members and friends don’t understand addiction and are easy to argue with or manipulate. Therapists and counselors may understand better, but a single person is also easy to question. Groups of peers who understand you, and have been there themselves are the hardest to ignore. There are many other helpful activities and strategies and research shows that the more you make use of, the better.

Before 12 step programs can work, there are two lessons that usually need to be learned. The first is that the addicted person needs to learn that he or she can’t succeed with controlled use. “Can’t I just have one or two and then stop?” Every addict would like to succeed at this, and sometimes it takes years to realize that it just won’t work. While the results of the experiment are still unclear, the addict won’t be able to identify with the 12 step group. The members will look like losers who’s lives are unmanageable. Only when the addict hits rock bottom and realizes that his or her own life is unmanageable, will the people in the 12 step meeting look like winners.

The second lesson is realizing that you can’t succeed alone. Many alcoholics and addicts want to be in sole control of their lives. They like to solve their problems on their own. It is hard for them to come to realize that their brain is owned jointly by themselves and MA. She has at least 50% of the shares, and will regularly win a vote. Once you understand this, you can see that you need outside allies to build a majority and start to win the decisions.

One final reason for hope. There are no guarantees, but this is as close as one can come: When alcoholics and addicts are willing to do as much as is necessary to get well, they will generally succeed. They may have to escalate their investment many times but, if they survive, their efforts will eventually pay off. The ones who don’t succeed are usually those who are only conditionally willing.

These are some of the key concepts that I use in working with people with addictions and their family members. They help me make sense of things that just don’t make sense. I hope they are of help to you as well. Of course, there is much more to doing a full evaluaton and developing a plan of action. Consulting an addiction professional is strongly recommended. For family members, please see also my post on codependency and look up Al anon and Nar anon, the 12 step programs for family members.

Can I just say what a comfort to find an individual who truly knows what they are talking about on the net. You actually know how to bring a problem to light and make it important. More and more people have to check this out and understand this side of the story. It’s surprising you are not more popular since you surely have the gift.

I agree with both points: controlled use isn’t the (permanent) answer and addiction cannot be overcome alone.

Just want to point out that the 12 Steps isn’t for everyone. I mean, there is no cookie-cutter way with dealing with addiction. We’re not cars made in an assembly line, identical in each way. We are individuals who have differ in many things, no matter how alike each of us are.

Just bought your book and have to say I’m dispirited after reading this post, I had a lot of hope for the teachings I would get from your book but to see you espouse the pseudo-religious 12 step model which does not have any evidence base to support it makes me worried I won’t be able to fully believe in your book… oh well such is life

Hi, Sosa56. I think of AA as a set of tools. They are good ones, easily available and free. To me it doesn’t make sense to research the results you get based on the tools you use. Success has more to do with how you use them. Many people who are not enthralled by the quasi-religious roots of AA are still able to use the tools, but others find the culture gap too great to bridge. If you have a set of tools that work better for your recovery, then more power to you.

By the way, the information in my book is supported both by research evidence, and by “practice-based evidence.” The latter is what one observes over years of practice where individual results matter. This kind of evidence sheds light on many urgent questions that are not amenable to statistical studies. It’s another tool that some may value and others regard as suspect. JS

Thanks very much for your reply. I agree with you RE practice-based evidence, after having just finished reading the body keeps the score I can see Dr van der kolk draws alot on observations and clinical intuition that may not be so amenable to clinical trials, a perennial problem in mental health and probably goes a long way to explaining why treatments such as CBT/medication dominate today. I can see how one would say 12 steps comes under this umbrella too, but it’s just something which seems so suspect. vulnerable people having to submit to a higher power to get better seems to run counter to the idea of developing agency and a strong sense of self that is crucial I understand to recovery (also tools like psychodynamic psychotherapy are now starting to develop a robust evidence base, something which it looks as though 12 steps will never achieve). I’ve heard Dr Gabor Mate speak on 12 step programs before and if I remember correctly he places stock in them as a social support network, which can be a useful element but that they shouldn’t be used as the central treatment, which I believe in the US they often are.
There’s an interesting article and discussion in the comments on the Atlantic (http://www.theatlantic.com/features/archive/2015/03/the-irrationality-of-alcoholics-anonymous/386255/), I’m sure you’ve probably already read it.